Jobs at PacificSource Health Plans

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, behavioral health, and outpatient services for medical necessity, appropriate level of care, and cost effectiveness. Coordinates discharge planning, community resources, vendors, providers, and multidisciplinary teams. Supports members and families, documents case decisions, interprets benefits and medical information, and assists with health services guidelines and procedures.

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, behavioral health, and outpatient services for medical necessity and appropriate utilization; coordinates discharge planning, referrals, vendors, providers, and community resources; supports members and families navigating healthcare systems; documents clinical and authorization decisions; collaborates with multidisciplinary teams and Medical Directors; and ensures compliance with health plan benefits, evidence-based criteria, HIPAA, and applicable regulations.

Provides utilization management and care coordination for health plan members. Reviews inpatient and behavioral health admissions, preauthorizations, continued stays, and discharge plans using evidence-based criteria. Coordinates medical, behavioral, community, and financial resources; supports members and families; negotiates with providers and vendors; documents clinical decisions; identifies high-cost cases; and advises internal teams on medical and benefit questions. Requires a licensed clinical professional with healthcare experience.

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, partial hospitalization, referral, and preauthorization cases; evaluates medical necessity and continued-stay appropriateness; coordinates discharge planning and community resources; negotiates with vendors and providers; supports members, families, employers, and internal teams; documents case information; and assists with healthcare guidelines, cost-effective care strategies, and quality outcomes.

Coordinates utilization management and care services for health plan members. Reviews inpatient, residential, behavioral health, and outpatient care for medical necessity and appropriate levels of care; supports discharge planning, referrals, authorizations, vendor negotiations, and member navigation. Collaborates with providers, multidisciplinary teams, employers, and Medical Directors while documenting case information, interpreting benefits, protecting health information, and identifying high-cost utilization.

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, behavioral health, and other treatment requests; evaluates medical necessity and continued stay using evidence-based criteria; coordinates discharge planning and community resources; supports preauthorization, provider negotiations, and high-cost case referrals; documents clinical decisions; assists members, families, providers, employers, and Medical Directors while maintaining HIPAA compliance.

Provides utilization management and care coordination for health plan members. Reviews inpatient and behavioral health admissions, preauthorization requests, continued stays, discharge plans, and evidence-based criteria. Coordinates medical, behavioral, community, and financial resources; supports members and families; negotiates provider arrangements; documents cases; identifies high-cost utilization; and advises internal teams on clinical and benefit matters. Requires collaboration with providers, multidisciplinary teams, employers, and health plan departments while maintaining HIPAA compliance.

Provides utilization management and care coordination for health plan members. Reviews inpatient, residential, partial hospitalization, referral, and preauthorization cases using evidence-based criteria. Coordinates discharge planning, community resources, vendors, providers, and multidisciplinary teams while assessing benefits, medical necessity, cost-effective care, and member outcomes. Documents clinical decisions, supports members and families, interprets medical and contractual information, and assists with health services guidelines and procedures.

Lead development, administration, and maintenance of compensation programs. Advise managers on pay decisions, conduct job evaluations and salary surveys, perform market benchmarking and internal equity analysis, ensure compliance with compensation laws, manage Workday/Payfactors compensation data, and support HR partners on rewards and benefits initiatives.

Develops, administers, and maintains compensation programs. Performs job analysis, wage grade design, market benchmarking, internal equity analysis, and compliance reviews. Advises managers on pay decisions, manages compensation projects, conducts salary surveys, and maintains compensation data in Workday. Partners with HR and business leaders to support attraction, retention, and compensation-related issues.

Develop, administer, and maintain compensation programs and guidelines. Conduct job analysis, wage grade design, salary benchmarking, market and internal equity analyses, and advise managers on pay decisions and compliance. Maintain compensation data in Workday and support HR strategic initiatives and compensation-related projects.

Leads provider network operations across Provider Relations, Provider Data Management, Credentialing, and platform interoperability. Oversees strategy, compliance, systems integration, provider education, budgets, performance, resource allocation, and large multi-level teams across Medicaid, Medicare, and Commercial lines of business. Partners with IT, analytics, finance, health services, and executive leadership to improve network operations, provider relationships, data accuracy, and organizational performance.

Lead Provider Network Operations overseeing provider relations, credentialing, data management, platform interoperability and compliance across Medicaid, Medicare and Commercial lines. Drive strategy, vendor partnerships, system integrations, automated workflows, LEAN improvements, budget and staffing, provider education, and cross-functional collaboration to meet performance and regulatory standards.

Lead Provider Network Operations across all lines of business, overseeing provider relations, data management, credentialing, and platform interoperability. Drive strategy, compliance (state, federal, NCQA), vendor/IT partnerships, process automation, budget and staff management, provider education, and performance metrics to improve provider engagement and network accuracy.

Lead Provider Network Operations overseeing provider relations, credentialing, data management, platform interoperability, and compliance. Drive strategic initiatives, vendor and IT partnerships, automated workflows, LEAN improvements, budgeting, staff development, and performance monitoring across Medicaid, Medicare, and Commercial lines of business.

Lead Provider Network Operations overseeing Provider Relations, Credentialing, Provider Data Management, and platform interoperability. Drive strategy, compliance (state, federal, NCQA), provider education, vendor partnerships, system integration, LEAN process improvements, budgeting, hiring and staff development, and cross-functional collaboration to meet performance metrics across Medicaid, Medicare, and Commercial lines.

Lead Provider Network Operations including Provider Relations, Data Management, Credentialing and platform interoperability. Drive strategy, compliance (state, federal, NCQA), automated workflows, vendor partnerships, provider education, budgeting, staffing, and performance metrics across Medicaid, Medicare and Commercial lines. Foster cross-functional collaboration with IT, Analytics, Finance and Operations to improve provider experience and data integrity.

Lead Provider Network Operations overseeing provider relations, data management, credentialing, and platform interoperability across lines of business. Drive strategy, vendor and IT partnerships, compliance (state, federal, NCQA), automated workflows, LEAN improvements, budgeting, staffing, and provider education. Manage performance metrics, cross-functional initiatives, and team development to improve provider collaboration and member access to care.

Lead Provider Network Operations overseeing Provider Relations, Data Management, Credentialing, and platform interoperability. Drive strategy, compliance (state, federal, NCQA, HIPAA), vendor partnerships, automation, and LEAN improvements. Manage budgets, hiring, staff development, cross-functional initiatives, provider education, and performance metrics across Medicaid, Medicare, and Commercial lines.

Develops, administers, and maintains compensation programs; processes compensation actions; conducts job analysis, salary surveys, benchmarking, and internal equity analysis; advises managers on pay decisions and compliance; maintains compensation data in Workday; leads compensation projects and partners with HR and business leaders to attract and retain talent.